The psychiatric emergency evaluation is the gateway into the mental health system. In this era of community based care, most initial evaluations are conducted in general hospital emergency rooms and result in involuntary treatment. These evaluations shape the character of the mental health system by selecting its clientele. Therefore, understanding of these evaluations and their effects is essential for rational policy making, planning and service. Having developed a reliable and valid index to measure patient standing on civil commitment criteria as clinically construed, we propose to address additional questions concerning evaluation and treatment of emergency room patients--e.g., quality of patient care, and protections of patient rights. The overall goal is to develop knowledge and tools for improved service consistent with informed policy and planning. The proposed study is and investigation of 772 psychiatric emergency evaluations observed in 9 public general hospital (7 in the San Francisco Bay Area, 1 in Fresno, and 1 in Los Angeles, California) using a battery of structured data-gathering and rating instruments. Observations were conducted at 3 points in time (1981, 1983-84, 1985-86). In addition to documenting the initial evaluation completely, the investigators checked the patient's records 1 year after the observation at the evaluating facility, and 18 months later checked California state criminal justice and vital statistic records. The follow-up record reviews were focused on possible negative consequences of evaluative procedures, including further emergency service utilization, criminal activity, and death following release. Proposed research analyses will: 1) clarify and test the assumptions upon which civil commitment policy is currently being made; 2) identify factors that can more thoroughly and efficiently promote better evaluations; 3) identify factors that can improve patient's rights protections; and 4) address issues of community concern regarding emergency room practice--e.g., the release of "public nuisances." Finally, the proposed research will 5) provide a package of evaluation instruments specific to the needs of the psychiatric emergency service that will not only enable better understanding of emergency assessments and more informed evaluation research but will also contribute over the long term to improvement of psychiatric emergency room training.